A 75-year-old woman with stable angina pectoris underwent percutaneous coronary intervention of the left anterior descending coronary artery, whereby a 3.25/16-mm paclitaxel-eluting absorbable metal scaffold (DREAMS, Biotronik, Bülach, Switzerland) was successfully implanted. Post-procedural angiography showed excellent results without pinching of the side branch ostium. The patient experienced no procedure-related complications, and was discharged 48 h after the procedure on dual antiplatelet therapy. Optical coherence tomography (OCT) (LightLab Imaging, Westford, Massachusetts) was performed post-procedure and at 12 months follow-up. Post-procedurally, the scaffold was well expanded with good apposition of struts to the vessel wall, and a side branch was jailed by the struts of DREAMS (Figs. 1A and 1B). At 12 months follow-up, OCT showed a smooth luminal surface with moderate neointimal hyperplasia in the scaffolded segment. Some remnants of struts were still visible with shadows (Fig. 1C′, yellow arrows). Interestingly, the struts overhanging a side branch ostium were partially replaced by a neointimal membranous bridge (Fig. 1B′, white arrow), whereas 3-dimensional OCT revealed the unobstructed and widely opened ostium of the side branch.

This is the first report to our knowledge of a serial OCT assessment in a case of overhanging struts at the ostium of a side branch after DREAMS implantation. Fully bioresorbable scaffolds are a novel therapeutic approach because they provide transient vessel support, in contrast to the permanent metallic stents. The DREAMS absorbable metal scaffold is made of a magnesium alloy, and is programmed to be absorbed and ultimately converted to hydroxyapatite 9 to 12 months following implantation (1). Previously, a similar case had been reported with the everolimus-eluting polymeric bioresorbable scaffold (Absorb BVS, Abbott Vascular, Santa Clara, California), but with a longer period (24 months) of bioresorption than in this case (2). This case highlights the resorption of the magnesium struts overhanging a side branch ostium, as illustrated in 3-dimensional OCT (3).

Footnotes

Dr. Waksman has received research grant support and consulting fees from Biotronik. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.